Simulated Patient Program

Simulated Patients are recruited from the community, and some are trained actors. They represent different parts of society and vary in terms of age, culture, language, ethnicity and life experience. Upon joining the program, Simulated Patients become casual employees of the University and are paid to attend training sessions as well as their simulated patient activities.

Simulated Patients play an important part in medical education providing a unique "patient" perspective to training.

History

Simulated patients were first used in the 1960s in undergraduate medical training in the United States of America. Since that time, many medical schools throughout the world have established Simulated Patient Programs, to enhance teaching and assessment. Simulated Patients are used for undergraduate and postgraduate teaching; research; and for projects that evaluate educational interventions. Simulated patients can be trained to work in a range of clinical scenarios, portray physical problems or symptoms, and work in conjunction with clinical equipment.

"Simulated patients" and "standardised patients" are often used interchangeably, but are not strictly the same thing. Simulated Patients (SPs) are trained to simulate realistic patient-clinician scenarios, and have been defined as "a normal person who has been carefully coached to present the symptoms and signs of an actual patient". Standardised Patients, in contrast, are those who have been trained to portray the medical scenario consistently - from patient to patient, and for student to student. In fact to ensure equity of teaching in addition to the important area of assessment, all SPs are ideally standardised for their work.

Benefits

The benefits for the use of simulated patients from an organisational perspective includes the ease of timetabling, repetition of the scenario, equity for student learning, and the ability to provide training in specialised and sensitive areas before the students are in a real life situation.

Insightful learning

The ability to gain insight into one's own performance after an event by personal reflection is an important part of learning. Similarly, receiving timely and appropriate feedback enhances and improves the learning experience. SPs are trained to encourage the students to use reflection and also to provide feedback from the patient perspective - a unique benefit from the SP Program that cannot be replicated in the clinical environment.

Safe patient practice

Simulated patients provide an authentic safe learning environment without harming real patients - this includes the importance of clear explanations to gain informed consent; instructions to patients on preparing for clinical examinations and tests; respectful care with patient handling; the safe use of equipment, and the demonstration of infection control in clinical practice.. Their use has been shown to be acceptable to learners with studies demonstrating that practicing clinicians are unable to distinguish between real and well-trained simulated patient.

Specific scenarios

In all sessions, whether for the purposes of learning or assessment, using Simulated Patients allows specific scenarios and conditions to be presented realistically.

Clinical scenarios can be written and portrayed to suit the educational purpose. A scenario can, for example be tailored to the level expected of students, with more complex cases later in the course. Similarly, scenarios can be scripted to focus on specific skills, or with specific conditions in mind.

Some issues are rarely dealt with by students with real patients because of their sensitive or challenging nature e.g. breaking bad news, intimate clinical examinations. For students to complete their training with no experience in these areas implies that they will meet these situations with no training nor supervision - an unacceptable situation in the 21st century. Simulated Patients are an excellent way of giving students experience in dealing with such issues, in an environment that is safe for both student and patient.

Activities

UQ's four-year medical degree incorporates the use of Simulated Patients (SPs) for clinical scenarios designed to develop or assess student medical interviewing skills and some clinical examination techniques.

Teaching tasks

In medical teaching sessions, Simulated Patients portray a specific patient case working with a small group of students or an individual student, with or without a tutor. This approach allows students to develop their reasoning and communication skills in a realistic, safe environment.

An important role for SPs is to ask the students to reflect on their performance and then provide feedback from the patient perspective (not on the medical content) - this is a unique situation and provides for the student an important learning opportunity that will not occur with real patients!

Assessment tasks

Simulated Patients are regularly required for medical students' Objective Structured Clinical Examinations (OSCEs), which are held during the year. These examinations are designed to assess students' communication and interpersonal skills as well as their diagnostic abilities through effective interviewing and/or examining of the Simulated Patient. To enable a fair and objective assessment of each student's skills, Simulated Patients need to play the patient role consistently and are therefore required to attend intensive training prior to OSCEs.

Health sciences education

Within the Faculty of Medicine, in Clinical Schools or community settings the SP Program can provide SPs for similar teaching and assessment tasks as described above. Sometimes these also involve portrayal of a physical problem e.g. for the physiotherapy program. Other activities may include working in a group activity or with equipment e.g. portrayal of a patient who is undergoing an intravenous cannulation or catheterisation (the invasive component on a synthetic model!).

Other organisations

Simulated Patients are also available to be utilised by other faculties within the university or organisations outside the university. This may include Queensland Health staff, postgraduate teaching and assessment for postgraduate doctors, nurses, and other professional groups.

Simulated Patients are also often required for research projects that measure the effectiveness of educational interventions.

Specialised simulated patients

Most simulated patients perform role plays - telling a patient story - for the students to practice their clinical skills. However, there are other specialised groups of SPs trained and organised through the SP Program:

Well woman check: a special group of women trained to teach the Well Woman check

Well man check: a special group of men trained to teach the well man check

Physical examination: medial students need to learn and be examined on a range of physical examinations e.g. examining the chest

SPs and the therapies: Physiotherapy, speech therapy and occupational therapy use SPs to train students in these important areas

Training

There are no particular qualifications to become an SP. We require people from all walks of life, across the adult age ranges and from all ethnic and cultural backgrounds. The work provides intermittent part-time employment. Men and women who work in his area find the work rewarding, gain knowledge, and improve their own self-esteem and confidence. The SPs form a supportive group of colleagues whose commitment is to improve student inter-personal communication and other skills for better long-term outcomes for patients or clients.

Application to become a simulated patient involves completion of an on-line or hard-copy form, an interview and attendance at a training session. This gives both the program and you an opportunity to see if you are suited or like this type of work. During your work you will be given feedback on your performance. At any time you may choose to leave the SP program; similarly, we may ask you to leave the program if it is perceived that you are not suited to the work.

Once your written and interview application has been accepted, you will need to take part in a Generic Training session before working as a Simulated Patient portraying patients. Payment is provided for this session. Generic Training sessions run for around 2.5 hours. The training provides an opportunity for you to practise being a Simulated Patient, and to learn about all aspects of the program.

In addition, Simulated Patients receive training for each role they portray. For experienced SPs or small role plays, the training may be held half an hour prior to the tutorial.

For assessment activities, however, the training is more intensive. Playing the patient role consistently is extremely important for any examination, which are designed to be a fair and objective assessment of each student's skills. To ensure a standard patient performance across Simulated Patients, case scripts and role training are provided one week prior to each examination and attendance at examination training sessions is compulsory. This training is usually between one and two hours long, and payment is provided.

Working conditions

In order to be paid for your work as a Simulated Patient, you will need to become a casual employee of The University of Queensland. The Human Resources (HR) information that you need to complete to become an employee is contained in the information pack sent to you when you join the program.

Simulated Patients are paid to attend training sessions, as well as for their work in simulated patient sessions/examinations. The program has a two-hour minimum engagement rule, which means that you are paid a minimum of two hours every time you work for the simulated patient program, regardless of actual time worked.

It is important to remember that, every time you work for the simulated patient program, you need to complete a casual timesheet. Completed timesheets should be submitted to the SP coordinator

Confidentiality, punctuality and reliability

We require Simulated Patients to attend all activities they have committed to and to be punctual. This is particularly so for student examinations, as one late arrival or non-attendance can hold up the entire examination and have serious consequences for students.

It is also essential that you maintain confidentiality, and that you do not:

Discuss scripts, scenarios or patient cases in a public place

Discuss scripts, scenarios or patient cases with others apart from those in the Program

Leave written materials in an area where they may be seen or taken

Discuss any particular student, examiner or other SP outside the program

Doing so may jeopardise examinations and lead to an unfair advantage for some students. All Simulated Patients are asked to sign a confidentiality agreement to say that they understand and will abide by these conditions.

Similarly, we ask both you and the students to respect each other's privacy; this includes -

Keeping a student performance confidential

Not sharing personal information with a student

Not asking a student for personal information about themselves

Acknowledging each other simply as student and teacher outside the teaching/assessment environment without particular details

Feedback / Debrief

After an examination session you will be offered a feedback form to allow you comment on aspects such as the Patient Case, the preparation for the role, and examiner behaviour. Likewise, the examiners fill in a feedback form on the performance of the Simulated Patient with whom they work in the examination.

This feedback guides us in the support we can offer Simulated Patients, how to improve Patient Cases and any other concerns.

At the end of an assessment session the SPs meet the coordinator to de-brief. This involves discussing the session, any concerns, and most importantly taking time to "come out of role" - essential when the role play was particularly emotional.

Occasionally you will have had an upsetting or emotional event that may be remembered with a particular role that you are asked to play. Make this known to the coordinator who will be able to assist, change the role if required, or offer you a de-briefing session. Your welfare is important to the program.

Apply

The Simulated Patients Program (SPP) accepts applications at any time.

Contact

The Simulated Patient Program is a vital part of medical education at UQ. Specially trained community members and trained actors are paid to attend training sessions and simulated patient activities to offer our students a unique "patient" perspective to learning.

We invite educators and organisations to make use of our experienced Simulated Patients. To request simulated patients and for a quote on costs contact: